Friday, July 25, 2014

Series: Technology, Morality, Power, AIDS Part VI of VI: Morality


What does this have to do with AIDS and ARVs?  AIDS is a frightfully powerful phenomenon.  Perhaps the best response to it is not to play its game—to try to overwhelm it with natural power.  Perhaps the best response is not a technological response, but a moral one.

Though they are of course technological, ARV’s are a good thing—a gift. They are saving the lives of millions. They are reducing transmission rates of HIV.  They have their place and they most certainly should be used.

But there are many today that believe that through the power of ARV’s, Africa may possibly be free of AIDS in a generation.  Two years ago, the cover of The Economist, a widely read and respected periodical, read: “The End of AIDS?”  The writer went on to explain why he and many of his persuasion think that because of new ARV technology, AIDS is all but beaten.  I question this.

If ARVs are so powerful, why in America, where we have all we want of the newest and best, are we still diagnosing new cases of HIV? There are new infections all the time.  As described above, I diagnose new cases in prison, a setting where free ARVs of the highest quality are physically handed to AIDS patients by a nurse twice daily. Despite the pinnacle of development and delivery of this technology, AIDS is hanging on in America despite the fact that ARVs are readily available and generally “free” to the patient.  (Though they must exist, I have never met an AIDS patient who pays for his own drugs). Pharmaceutical companies are spending hundreds of millions developing new drugs.  Would they be doing that if they expected AIDS to disappear?  But these are superficial arguments.

Five percent of the children in a typical African village are malnourished, even during harvest time, when food is plentiful in the community.  At this very moment, there are malnourished children waking up in homes within a few miles of where I sit.  What is the solution for malnutrition?  It’s corn and beans.  That “technology” has been around for millennia, and is manufactured right here in the village in large amounts by local people.  Yet malnutrition remains a common cause of death.  If less than 100% of the people are getting food, which is cheap and grown in the village, how can we expect 100% of the people who need ARVs to get them?  Simply delivering technology to people is not as easy as it may seem.

We have pushed condoms as a solution for AIDS for over two decades. The approach has largely failed.  ARV’s do a good thing.  They often keep an infected person well.  That person may live a long life.  ARVs should in no case be withheld from an individual that could be helped by them.  But the person who claims that ARV’s will be the end of aids is hoping that ARV’s will dramatically reduce the rate of new HIV infections—because for it to be truly the end of AIDS, that would have to happen.  ARVs are, in a sense, chemical condoms. Except for a few major differences: they are much more expensive, they have more and worse side effects, they are more dangerous, they are rarely manufactured on this continent (they have to be shipped in from elsewhere), they are less well understood, are harder to store, and are harder to manufacture and distribute.  Is it safe to assume that ARVs will be more successful than condoms have been?

And there is another difference that is pointed out to me by Africans all the while.  It used to be that you could at least tell who had active AIDS because they looked very sick.  With the advent of readily available ARV’s, now many people who are HIV positive don’t look sick. People who are seeking sexual partners cannot easily tell whom to avoid.  Now people fear that new infections will rise, because the promiscuous are taking risks without knowing it.

Morality actually could eradicate AIDS in a generation.   Abstinence before marriage and faithfulness during marriage have done tremendous things to decrease HIV rates in places such as Uganda.  Morality is inexpensive, has good side effects, doesn’t have to be manufactured, stored, or imported, and most importantly, comes from within the people themselves.

Morality is the resignation of the power of the "kingdom of self".  It is submission to a supremely good higher power.  God’s power in peoples lives, His empowerment to behave the way he has instructed us, really could stop AIDS.  Think about it.  What if people were faithful?

Please don’t misunderstand me.  Widespread use of ARVs is not a bad idea.  They absolutely have their place in stemming the tide of AIDS. But they cannot stand alone.  One of my frustrations in the last ten years in Africa has been how hard it can be to get ARVs in the village.  I wish we could get them.  I would not wish that if I thought they were foolish.  But I do think that hoping in ARVs as the end of AIDS is totally naïve. Just as Man is much more than just a physical body, HIV is much more than just a virus.  Reality is more than it seems, not less.  The solution is going to have to go a whole lot deeper than just a bottle of pills.

Beware the technological solution for a moral problem.